Shane Klingonsmith, D.M.D

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS036069 Issued in PA

Practice address

4555 Easton Ave
Bethlehem, PA 18020-9343

Phone

(610) 866-0552

NPI assigned

Oct 24, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359331200000",
    "number": "1205910767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4555 EASTON AVE",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180209343",
            "telephone_number": "610-866-0552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4555 EASTON AVE",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180209343",
            "telephone_number": "610-866-0552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLINGONSMITH",
        "first_name": "SHANE",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2013-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS036069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sophia Klevan
• Kinsey Erin Kliment
• Sundra Kline, RN
• Amy Elizabeth Klingner Previato, LMT
• Sara Jane Klingner, RN
• Abigail Klitsch, D.O.
• Jeffrey Klucsarits
• Kathleen Jeannette Knaack
• Sean Knapp
• Jill Buehler Knerr, MSW

• General Practice Dentistry in Bethlehem, PA
• Providers in Bethlehem, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.